Mostashari Evaluates EHR Study

Study concluding that EHRs may lead to more ordering of tests tells us little about the impact of EHRs, Mostashari says

A new study appearing in the March issue of Health Affairs found that doctors who have electric systems order more imaging tests. The study concludes that EHRs could be responsible for driving healthcare costs up because of the convenience of ordering new tests.

Dr. Farzad Mostashari, national coordinator for health information technology, responded to this study at a HITPC meeting and on the Health IT Buzz blog shortly after the study’s results were released. Mostashari spoke against the study, saying that “while such interpretations may make for attention-getting media headlines, it’s important to get the facts.” He continued: “There are several reasons why McCormick’s study ultimately tells us little about the ability of electronic health records (EHRs) to reduce costs, and why it tells us nothing about the impact of EHRs on improving care.”

The first reason should be fairly obvious: the study was not about EHRs at all, or even meaningful use. Rather, the study focused on how physicians react to electronic viewing of imaging results. The study was conducted in 2008, a full three years before the meaningful use program was launched, and the study itself stated that “use of an electronic health record system showed no association with test ordering.”

Second, “this was not a randomized trial, but an observational study . . . that was not designed to answer the question of costs, or associations between EHRs and quality,” Mostashari said, referencing David Brailer’s New York Timesarticle. Many variables could have contributed to increased ordering of tests, from having a sicker patient population to a physician’s financial arrangements.

Mostashari clearly states that reducing test orders is not the way that health IT is meant to reduce costs anyway. “The ultimate impact of EHRs on reducing cost will be through improvements in the coordination and quality of care, and the prevention of unnecessary and costly complications and hospitalizations,” he said.

In conclusion, Mostashari urges healthcare professionals to get the facts before making assumptions. “The evidence shows we are on the right track to establishing the health IT foundations for a true 21st Century U.S. health system where patients get better care, while we reduce health care costs.”